Before (Hip replacement) Surgery:

Preparing yourself and your home before hip replacement surgery can seem like a stressful and daunting task. Planning ahead of time for your surgery and hospital stay can have a positive impact on the success of your surgery. Learn more about preparing for your hospital stay, organizing your home and any preoperative tests and medications.

What Causes Chronic Hip Pain?

++ Osteoarthritis
Osteoarthritis is sometimes referred to as "degenerative" or "wear-and-tear" arthritis, and is the most common type of arthritis. In osteoarthritis, the cartilage covering the bone ends gradually wears away. At its most advanced stage, the joint cartilage is completely eroded - down to the bone. Degeneration of joint cartilage and changes in underlying bone and supporting tissues lead to pain, stiffness, movement problems and activity limitations. All joints may be affected by osteoarthritis, but it is often more painful in weight-bearing joints -hip, knee, spine.

++ Rheumatoid Arthritis
Rheumatoid arthritis is a systemic disease that affects people of all ages, including children. In rheumatoid arthritis, the body's immune system produces a chemical that attacks and destroys the lining of the joint, the cartilage and the joint surface itself. Consequently, swelling, pain, joint damage and loss of mobility occur - even if the joint isn't used. Rheumatoid arthritis often affects the wrist joints and the finger joints closest to the hand.

++ Trauma-Related Arthritis
Trauma-related arthritis occurs when the joint is injured -- for instance, in a fall or an auto accident.

Regardless of the type of arthritis, the disease can cause symptoms of joint pain, stiffness, limping, muscle weakness, limitation of motion and swelling. Pain is the main problem with advanced arthritis in any joint. Depending on the joint affected and the amount of damage, ordinary activities such as walking, putting on socks and shoes, getting in and out of cars, and climbing stairs may be difficult. As the condition worsens, symptoms worsen.

What Your Orthopaedics Doctor Considers before surgery?

You are a candidate for a total hip replacement. You have met with your surgeon, and he or she has outlined the procedure and what implant will be used.

But just how does your surgeon make the decision of which hip implant to use?

Years ago, surgeons and patients had few options for total hip replacement. But advances have been made in hip replacement since the first surgery was performed in the U.S. in the late 1960s. Improvements in the endurance and compatibility of materials used in hip replacement surgery offer new ways to help patients of any age, including younger, more active patients needing a hip replacement. The design of artificial hips takes into consideration the hip joint forces, strength of the mechanism, ease of implantation and fit, wear and durability, chemical compatibility, and surface finish of each design.

When a surgeon makes a decision about which implant to use, he or she takes into consideration several important factors, such as stability, range of motion, and wear resistance as well as your lifestyle, gender, age, and weight. Stability is the degree of resistance to the forces causing movement or change of movement. It directly affects range of motion or the arc created by flexing a limb at the joint. Affecting both stability and range of motion is the artificial bearing’s wear resistance, the resistance of the bearing to friction and subsequent erosion. These factors affect the life of the hip implant.

In the past, patients had just one choice when considering total hip replacement—metal-on-polyethylene bearings. Today, patients have the additional options of metal-on-metal, ceramic-on-polyethylene, and ceramic-on-ceramic hip components.

++ Metal-on-polyethylene implants are considered the “traditional” bearing for total hip replacement. It consists of a metal stem
     inserted into the femur, and a polyethylene cup, usually embedded in a metal shell, that is attached to the pelvis. A metal ball
     at the end of the stem rides in the cup.

++ Metal-on-metal hip implants combine a metal femoral stem, femoral ball and cup.

++ Ceramic-on-polyethylene implants combine a metal femoral stem and a ceramic femoral head with a polyethylene cup
     embedded in a metal shell. Ceramic heads are very difficult to scratch. The hard, scratch resistant, ultra smooth surface can
     reduce the wear rate when used with a polyethylene cup.

Information Needed by your Orthopaedic Surgeon

Some preparation before your visit to the orthopaedic surgeon can help make your visit go more smoothly. Below are some suggestions of what type of information to bring with you to an appointment. Your medical history, both recent and past, including information about:

++ Other medical conditions
++ Previous surgeries
++ Previous injuries
++ Information about your medications, including the dosage and strength:
++ Over-the-counter Prescription
++ Information about any nutritional supplements such as vitamins, herbal supplements, glucosamine, etc.
++ Information about any allergies you have
++ Information about previous tests done to assess your symptoms

This information can help your orthopaedic surgeon assess your situation leaving more time to discuss your symptoms and activity level.

The Night Before Joint Replacement Surgery

The night before surgery may be a restless night for you as you prepare mentally for the surgery. This is to be expected, so don't be alarmed. If you need to take a mild sedative to get to sleep, that's fine. Be sure to take all of your normal medications unless the doctor has instructed you not to take certain medications.

Medications such as "blood thinners" (coumadin, aspirin, ibuprofen and the other anti- inflammatory medications) may cause a greater blood loss. Your doctor has probably already asked you to stop taking these medications. Ask to make sure!

You can eat about anything you wish the night before surgery. You can eat solid food until midnight. After midnight, you should not eat or drink anything unless your doctor has told you otherwise. This means nothing - not coffee, not water, not ice chips.

To ensure your are properly prepared, make sure you have everything you'll need at the hospital, that all of your questions are answered, and that you have your advanced directives available if you wish.
 

Joint Replacement surgery has seen many recent developments and now gives consistently gratifying results using appropriate implants in the respective age groups. However it is a major surgical undertaking and must be given the utmost care and preparation. It is never an emergency procedure and thus the patient must be in an  ‘Best possible condition’ at the time of the surgery..

Preparation and investigations for the surgery is done from 3 different profiles.

1. Fitness to have anaesthetic

2. To detect hidden sources of infection in the body

3. To help the surgeon in the technical planning for the operation